Transrectal ultrasound study of prostate.

Better detection of prostate cancer has been achieved in this study of a limited number of patients by the combined use of digital rectal examination and transrectal ultrasound examination. With more experience and modern equipment improved detection of prostate cancer can be expected.

The surgeon's future role in the conquest of cancer.

This article is a brief review alluding to the multidisciplinary modalities including basic science technologies that are available in the treatment of today's cancer victim. The roles are discussed of the general surgeon and of the surgical fellow, later a surgical oncologist, as they merge into their respective positions to practice their art. The necessity of limiting the number of surgical oncologists with helpful hints on how they can survive in a nonacademic atmosphere are presented. The multidisciplinary approach to treatment of cancer is stressed.

Carcinoma of the pancreas: progress or stalemate?

Has treatment for cancer of the pancreas progressed or has a stalemate been reached? This is a difficult question to answer. Cancer of the pancreas has several unique features. First, it has been an extremely difficult tumor to study because of its anatomic location and our present invasive and non-invasive studies have failed to provide for truly early detection of this disease when cure may be possible. Second, assuming that we are able to diagnose early, radical surgical resection (our best treatment to date) still carries a substantial morbidity and mortality. The direction certainly has to be in early detection and screening in the asymptomatic patient. To date all of our therapy is directed to the patient who already has symptoms. Diagnosis prior to this stage of the disease is imperative. This would entail the use of biological and serum antibody-type screening procedures with specific tumor markers and better epidemiologic studies to identify risk factors which would aid in screening procedures. It is apparent that present day techniques in the diagnosis and directions are needed before any significant improvement in survival rates are realized.

Exogenous estrogens and other risk factors for breast cancer in women with benign breast diseases.

A group of 1,439 white women who were initially treated for biopsy-proved benign breast diseases from 1942 to 1975 in a single private surgery practice were followed through 1976 for development of breast cancer. Information on age, parity, and use of noncontraceptive estrogens was collected on all women at the time of their initial benign lesions. At follow-up, ages at menarche, menopause, and birth of first child were obtained, as was information on use of estrogens after the initial lesion. Slides from the initial lesion were reinterpreted and classified by a panel of pathologists. The influence of gross and microscopic features of the initial benign conditions on subsequent risk of breast cancer was ascertained and reported previously. This paper presents results of additional analyses based largely on Cox's proportional hazards model. Risk of breast cancer was related to nulliparity and ages at menarche and birth of first child and to a lesser extent to age at artificial menopause. Exogenous estrogen taken prior to the initial benign lesion did not alter risk of breast cancer. Subsequent use, primarily of conjugated estrogens, eliminated the protective effect of an artificial menopause and appeared to act synergistically with epithelial hyperplasia or papillomatosis in the initial lesion and calcification of that lesion to increase the risk of breast cancer. A marked increase in risk of breast cancer in succeeding birth cohorts was unexpectedly found that could not be explained by temporal changes in any of the other risk factors considered.

Risk of breast cancer in women with benign breast disease.

A group of 1,489 white women were treated in a private surgery practice from 1940 through 1975 for biopsy-proved benign breast disease, and 1,441 were followed through 1976 for the development of breast cancer. Average duration of follow-up was 12.9 years for a total of 18,617 person-years of observation. Information was collected from a set of questions devised in 1941 and asked of all subjects at the time of their initial office visit, follow-up interview conducted in 1976, and a standardized histology review of the slides from the initial benign lesions and the subsequent cancers. The current pathology review indicated that 66 of the women developed breast cancer. The incidence rate was 3.55 per 1,000 person-years, which is 2.10 times that of the general population. When multiple disease types and other variables were controlled for, excess risk of breast cancer was related to the presence of fibrocystic disease. In women with fibrocystic disease, excess risk was particularly related to the presence of epithelial hyperplasia and/or papias not related to the presence of fibroadenoma alone, but it was related to the presence of fibroadenoma in women with concomitant fibrocystic disease. The excess risk was also directly related to the estimated size of the initial benign mass and was greater for women with bilateral than with unilateral benign lesions.

Carcinoma of the esophagus.

We review 10 years' experience with cancer of the thoracic esophagus with an additional minimal six-year observation period of a few surviving patients. Differences must exist in this tumor because therapeutic response, especially irradiation varies in different localities. Very few intrathoracic cancers in our series were resectable. Operation or operation with irradiation produced the only longtime survivors. The number of candidates for resection can probably be increased by preoperative irradiation. Considering the lack of good methods of early detection, the technical problems of the fraility of the tissues involved and their locations, the survival time of the resected patients was surprisingly good. Until entirely new concepts of treatment are introduced, our efforts should be directed toward earlier detection if improved results are to be anticipated.

The establishment of a cancer center.

This article describes the designated comprehensive cancer center in the Pacific Northwest section of the United States. The local financial, political, and medical problems associated with the initial establishment of this center are discussed. The general philosophy of the approach to cancer, cancer research, and care are included. The programs described differ very little from other similar centers with exceptions that are noted. These are the establishment of the major clinical facilities or units outside of the center proper. The utilization, not duplication, of already existing surgical, irradiation, and hospital facilities representing a departure from the usual custom is discussed. Active participation with real input by the physicians of our region through the extramural council is described.

Breast masses in males with carcinoma of the prostate.

Breast masses in male patients who have prostatic carcinoma may represent gynecomastia secondary to estrogen therapy, metastasis of the prostatic carcinoma to the breast, or a primary carcinoma of the breast. Accurate diagnosis of this lesion by biopsy and, if possible, histochemical determination of acid phosphatase is essential to determine prognosis and treatment. The patient with breast metastases from a primary prostatic carcinoma will survive on the average only 4 mo. However, in the patient with prostatic carcinoma, surgical treatment for a primary breast carcinoma may extend survival considerably.